Skip to main content
SpringerLink
Log in

The Burden of Osteoporosis and the Case for Disease Management

  • Review Article
  • Published:
Disease Management & Health Outcomes

Abstract

Currently, osteoporosis, defined as low bone mineral density (BMD), affects 30% of postmenopausal women and 8% of men >50 years old in Western society and these percentages are likely to increase as our elderly population expands. Osteoporosis-related fractures increase with age and reductions in BMD, with the greatest increase in hip, followed by vertebral, and then wrist fractures. Osteoporosis is associated with significant mortality and for each 1 SD decrease in BMD there is a 1.5-fold increase in mortality risk. Following a hip fracture, 25–30% of patients will die within 3–6 months and in some populations hip fractures account for 1.5% of all deaths. Osteoporosis and related fractures are associated with significant morbidity, with loss of independence, psychological effects, and an overall decreased quality of life.

The current financial cost of osteoporosis in the US is $US14 billion and in the UK just over £1 billion, and these costs will increase 3- to 8-fold over the next 50 years. Treatments are available that have been shown to significantly increase BMD, decrease bone turnover, and as a result decrease fracture incidence. For reductions in both vertebral and fracture, the evidence is strongest for the use of the bisphosphonates alendronate and risedronate; while for vertebral fracture, effective treatments include raloxifene, etidronate, calcitonin, and calcium plus vitamin D. Recent data suggest that hormone replacement therapy (HRT) can prevent hip and vertebral fractures, but long-term use, or commencement in elderly women of some continuous combined preparations, is no longer recommended.

It has been recognized that bone turnover and bone quality contribute to fracture risk and, therefore, biochemical assessment of bone resorption and formation may increase the clinical and cost effectiveness of treatment. Using a conservative estimate of fracture reduction (35%) over a 5-year period, an intervention costing $US500 (£333) per year is cost effective when targeted to women with osteoporosis who are ≥65 years of age. It has been calculated that the lower the intervention cost and the higher the effectiveness of treatment the lower the age at which the treatment would be cost effective. The increasing healthcare burden and effective treatments make osteoporosis an excellent candidate for disease management programs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Table III
Table IV

Similar content being viewed by others

References

  1. Consensus development conference: prophylaxis and treatment of osteoporosis. Osteoporos Int 1991; 1: 114-7

    Google Scholar 

  2. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 1993; 94: 646-50

    Google Scholar 

  3. Kanis JA, Melton III LJ, Christiansen C, et al. The diagnosis of osteoporosis. J Bone Miner Res 1994; 9: 1137–41

    Article  PubMed  CAS  Google Scholar 

  4. World Health Organisation. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Geneva: WHO technical report series 843, 1994

    Google Scholar 

  5. Ross PD. Predicting bone loss and fracture risk with biochemical markers: a review. J Clin Densitom 1999; 2: 285–94

    Article  PubMed  CAS  Google Scholar 

  6. Johnell O, Oden A, De Laet C, et al. Biochemical indices of bone turnover and the assessment of fracture probability. Osteoporos Int 2002; 13: 523–6

    Article  PubMed  CAS  Google Scholar 

  7. Kanis JA, Johnell O, Oden A, et al. Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone 2000; 27: 585–90

    Article  PubMed  CAS  Google Scholar 

  8. Singer BR, McLauchlan GJ, Christie J, et al. Epidemiology of fractures in 15,000 adults: the influence of age and gender. J Bone Joint Surg Br 1998; 80: 243–8

    Article  PubMed  CAS  Google Scholar 

  9. Kanis JA, Johnell O, Oden A, et al. Ten-year risk of osteoporotic fracture and the effect of risk factors on screening strategies. Bone 2002; 30: 251–8

    Article  PubMed  CAS  Google Scholar 

  10. Browner WS, Seeley DG, Vogt TM, et al. Non-trauma mortality in elderly women with low bone mineral density: study of Osteoporotic Fractures Research Group. Lancet 1991; 338: 355–8

    Article  PubMed  CAS  Google Scholar 

  11. Gardsell P, Johnell O. Bone mass-a marker of biologic age? Clin Orthop 1993; 287: 90–3

    PubMed  Google Scholar 

  12. Johansson C, Black D, Johnell O, et al. Bone mineral density is a predictor of survival. Calcif Tissue Int 1998; 63: 190–6

    Article  PubMed  CAS  Google Scholar 

  13. Richmond J, Aharonoff GB, Zuckerman JD, et al. Mortality risk after hip fracture. J Orthop Trauma 2003; 17(1): 53–6

    Article  PubMed  Google Scholar 

  14. Elliot J, Beringer T, Kee F, et al. Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol 2003; 56(8): 788–95

    Article  Google Scholar 

  15. Rose S, Maffulli N. Hip fractures: an epidemiological review. Bull Hosp Jt Dis 1999; 58(4): 197–201

    PubMed  CAS  Google Scholar 

  16. Kanis JA, Oden A, Johnell O, et al. The components of excess mortality after hip fracture. Bone 2003; 32: 468–73

    Article  PubMed  CAS  Google Scholar 

  17. Cauley JA, Thompson DE, Ensrud KC, et al. Risk of mortality following clinical fractures. Osteoporos Int 2000; 11: 556–61

    Article  PubMed  CAS  Google Scholar 

  18. Ismail AA, O’Neill TW, Cooper C, et al. Mortality associated with vertebral deformity in men and women: results from the European Prospective Osteoporosis Study (EPOS? Osteoporos Int 1998; 8: 291–7

    Article  PubMed  CAS  Google Scholar 

  19. Melton III LJ, Therneau TM, Larson DR. Long-term trends in hip fracture prevalence: the influence of hip fracture incidence and survival. Osteoporos Int 1998; 8: 68–74

    Article  PubMed  Google Scholar 

  20. Kado DM, Browner WS, Palermo L, et al. Vertebral fractures and mortality in older women: a prospective study: study of Osteoporotic Fractures Research Group. Arch Intern Med 1999; 159: 1215–20

    Article  PubMed  CAS  Google Scholar 

  21. Center JR, Nguyen TV, Schneider D, et al. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 1999; 353: 878–82

    Article  PubMed  CAS  Google Scholar 

  22. Forsen L, Sogaard AJ, Meyer HE, et al. Survival after hip fracture: short- and longterm excess mortality according to age and gender. Osteoporos Int 1999; 10: 73–8

    Article  PubMed  CAS  Google Scholar 

  23. Black DM, Arden NK, Palermo L, et al. Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures: Study of Osteoporotic Fractures Research Group. J Bone Miner Res 1999; 14: 821–8

    Article  PubMed  CAS  Google Scholar 

  24. Klotzbuecher CM, Ross PD, Landsman PB, et al. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 2000; 15: 721–39

    Article  PubMed  CAS  Google Scholar 

  25. Lauritzen JB, Lund B. Risk of hip fracture after osteoporosis fractures: 451 women with fracture of lumbar spine, olecranon, knee or ankle. Acta Orthop Scand 1993; 64: 297–300

    Article  PubMed  CAS  Google Scholar 

  26. Melton III LJ, Atkinson EJ, Cooper C, et al. Vertebral fractures predict subsequent fractures. Osteoporos Int 1999; 10: 214–21

    Article  PubMed  Google Scholar 

  27. Kanis JA. Treatment of osteoporotic fracture. Lancet 1984; I: 27–33

    Article  Google Scholar 

  28. Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA 2001; 285: 320–3

    Article  PubMed  CAS  Google Scholar 

  29. Martin AR, Sornay-Rendu E, Chandler JM, et al. The impact of osteoporosis on quality-of-life: the OFELY cohort. Bone 2002; 31: 32–6

    Article  PubMed  CAS  Google Scholar 

  30. Roberto KA. Stress and adaptation patterns of older osteoporotic women. Women Health 1988; 14: 105–19

    Article  PubMed  CAS  Google Scholar 

  31. Eddy D, Johnston C, Cummings SR. Osteoporosis: review of the evidence for prevention, diagnosis, and treatment and cost-effectiveness analysis. Osteoporosis Int 1998; 8: S1–8

    Google Scholar 

  32. Schneider EL, Guralnik JM. The aging of America: impact on health care costs. JAMA 1990; 263: 2335–40

    Article  PubMed  CAS  Google Scholar 

  33. Dolan P, Torgerson DJ. The cost of treating osteoporotic fractures in the United Kingdom female population. Osteoporos Int 1998; 8: 611–7

    Article  PubMed  CAS  Google Scholar 

  34. Dolan P, Torgerson DJ. The cost of treating osteoporotic fractures in the United Kingdom female population. Osteoporosis Int 2000; 11: 551–2

    Article  Google Scholar 

  35. Burge RT, Worley D, Johansen A, et al. The cost of osteoporotic fractures in the UK: projections for 2000-2020. J Med Econ 2001; 4: 51–2

    Article  Google Scholar 

  36. Finnern HW, Sykes DP. The hospital cost of vertebral fractures in the EU: estimates using national datasets. Osteoporosis Int 2003; 14: 429–36

    Article  Google Scholar 

  37. Ray NF, Chan JK, Thamer M, et al. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 1997; 12: 24–35

    Article  PubMed  CAS  Google Scholar 

  38. Greendale GA, Barrett-Connor E, Ingles S, et al. Late physical and functional effects of osteoporotic fracture in women: the Rancho Bernardo Study. J Am Geriatr Soc 1995; 43: 955–61

    PubMed  CAS  Google Scholar 

  39. Ray NF, Chan JK, Thamer M, et al. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 1997; 12: 24–35

    Article  PubMed  CAS  Google Scholar 

  40. Salkeld G, Cameron ID, Cumming RG, et al. Quality of life related to fear of falling and hip fracture in older women: a time trade off study. BMJ 2000; 320: 341–6

    Article  PubMed  CAS  Google Scholar 

  41. Christodoulou C, Cooper C. What is osteoporosis? Postgrad Med J 2003; 79: 133–8

    Article  PubMed  CAS  Google Scholar 

  42. Cooper C, Atkinson EJ, Jacobsen SJ, et al. Population-based study of survival after osteoporotic fractures. Am J Epidemiol 1993; 137: 1001–5

    PubMed  CAS  Google Scholar 

  43. Browner WS, Pressman AR, Nevitt MC, et al. Mortality following fractures in older women: the study of osteoporotic fractures. Arch Intern Med 1996; 156: 1521–5

    Article  PubMed  CAS  Google Scholar 

  44. Kanis JA, Torgerson D, Cooper C. Comparison of the European and USA practice guidelines for Osteoporosis. Trends Endocrinol Metab 2000; 11: 28–32

    Article  PubMed  CAS  Google Scholar 

  45. Deutschmann HA, Weger M, Weger W, et al. Search for occult secondary osteoporosis: impact of identified possible risk factors on bone mineral density. J Intern Med 2002; 252: 389–97

    Article  PubMed  CAS  Google Scholar 

  46. Cranney A, Guyatt G, Griffith L, et al. Meta-analyses of therapies for postmenopausal osteoporosis: IX. Summary of meta-analyses of therapies for postmenopausal osteoporosis. Endocr Rev 2002; 23: 570–8

    Article  PubMed  CAS  Google Scholar 

  47. Ferrar L, Jiang G, Barrington NA, et al. Identification of vertebral deformities in women: comparison of radiological assessment and quantitative morphometry using morphometric radiography and morphometric X-ray absorptiometry. J Bone Miner Res 2000; 15: 575–8

    Article  PubMed  CAS  Google Scholar 

  48. McCloskey EV, Spector TD, Eyres KS, et al. The assessment of vertebral deformity: a method for use in population studies and clinical trials. Osteoporos Int 1993; 3: 138–47

    Article  PubMed  CAS  Google Scholar 

  49. Eastell R, Cedel SL, Wahner HW, et al. Classification of vertebral fractures. J Bone Miner Res 1991; 6: 207–15

    Article  PubMed  CAS  Google Scholar 

  50. Delmas PD, Ensrud KE, Adachi JD, et al. Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. J Clin Endocrinol Metab 2002; 87(8): 3609–17

    Article  PubMed  CAS  Google Scholar 

  51. Chesnut III CH, Silverman S, Andriano K, et al. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrance of osteoporotic fractures study. PROOF Study Group. Am J Med 2000; 109(4) 267–76

    CAS  Google Scholar 

  52. Boonen S, Haentjens P, Vandenput L, et al. Preventing osteoporotic fractures with antiresorptive therapy: implications of microarchitectural changes. J Intern Med 2004; 255(1): 1–12

    Article  PubMed  CAS  Google Scholar 

  53. Looker AC, Bauer DC, Chesnut III CH, et al. Clinical use of biochemical markers of bone remodeling: current status and future directions. Osteoporos Int 2000; 11: 467–80

    Article  PubMed  CAS  Google Scholar 

  54. Ross PD, Kress BC, Parson RE, et al. Serum bone alkaline Phosphatase and calcaneus bone density predict fractures: a prospective study. Osteoporos Int 2000; 11: 76–82

    Article  PubMed  CAS  Google Scholar 

  55. Ravn P, Clemmesen B, Christiansen C. Biochemical markers can predict the response in bone mass during alendronate treatment in early postmenopausal women: Alendronate Osteoporosis Prevention Study Group. Bone 1999; 24: 237–44

    Article  PubMed  CAS  Google Scholar 

  56. Cadogan J, Eastell R, Jones N, et al. Milk intake and bone mineral acquisition in adolescent girls: randomised, controlled intervention trial. BMJ 1997; 315: 1255–60

    Article  PubMed  CAS  Google Scholar 

  57. Cranney A, Tugwell P, Wells G, et al. Meta-analyses of therapies for postmenopausal osteoporosis: I. Systematic reviews of randomized trials in osteoporosis: introduction and methodology. Endocr Rev 2002; 23: 496–507

    Article  PubMed  Google Scholar 

  58. Cranney A, Wells G, Willan A, et al. The Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group Meta-analyses of therapies for postmenopausal osteoporosis: II. Meta-analysis of alendronate for the treatment of postmenopausal women. Endocr Rev 2002; 23: 508–16

    Article  PubMed  CAS  Google Scholar 

  59. Cranney A, Tugwell P, Adachi J, et al. The Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group. Meta-analyses of therapies for postmenopausal osteoporosis: III. Meta-analysis of risedronate for the treatment of postmenopausal osteoporosis. Endocr Rev 2002; 23: 517–23

    Article  PubMed  CAS  Google Scholar 

  60. Cranney A, Tugwell P, Zytaruk N, et al. The Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group. Meta-analyses of therapies for postmenopausal osteoporosis: IV. Meta-analysis of raloxifene for the prevention and treatment of postmenopausal osteoporosis. Endocr Rev 2002; 23: 524–8

    Article  PubMed  CAS  Google Scholar 

  61. Wells G, Tugwell P, Shea B, et al. The Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group. Meta-analyses of therapies for postmenopausal osteoporosis: V. Meta-analysis of the efficacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal women. Endocr Rev 2002; 23: 529–39

    Article  PubMed  CAS  Google Scholar 

  62. Cranney A, Tugwell P, Zytaruk N, et al. The Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group. Meta-analyses of therapies for postmenopausal osteoporosis: VI. Meta-analysis of calcitonin for the treatment of postmenopausal osteoporosis. Endocr Rev 2002; 23: 540–51

    Article  PubMed  CAS  Google Scholar 

  63. Shea B, Wells G, Cranney A, et al. The Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group.Meta-analyses of therapies for postmenopausal osteoporosis: VII. Meta-analysis of calcium supplementation for the prevention of postmenopausal osteoporosis. Endocr Rev 2002; 23: 552–9

    Article  PubMed  CAS  Google Scholar 

  64. Papadimitropoulos E, Wells G, Shea B, et al. The Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group. Meta-analyses of therapies for postmenopausal osteoporosis: VIII. Meta-analysis of the efficacy of vitamin D treatment in preventing osteoporosis in postmenopausal women. Endocr Rev 2002; 23: 560–9

    Article  PubMed  CAS  Google Scholar 

  65. Naessen T, Persson I, Adami HO, et al. Hormone replacement therapy and the risk for first hip fracture: a prospective, population-based cohort study. Ann Intern Med 1990; 113: 95–103

    PubMed  CAS  Google Scholar 

  66. Cauley JA, Seeley DG, Ensrud K, et al. Estrogen replacement therapy and fractures in older women: study of Osteoporotic Fractures Research Group. Ann Intern Med 1995; 122: 9–16

    PubMed  CAS  Google Scholar 

  67. Michaelsson K, Baron JA, Farahmand BY, et al. Hormone replacement therapy and risk of hip fracture: population based case-control study. The Swedish Hip Fracture Study Group. BMJ 1998; 316: 1858–63

    Article  PubMed  CAS  Google Scholar 

  68. Torgerson DJ, Bell-Syer SE. Hormone replacement therapy and prevention of nonvertebral fractures: a meta-analysis of randomized trials. JAMA 2001; 285: 2891–7

    Article  PubMed  CAS  Google Scholar 

  69. Torgerson DJ, Bell-Syer SE. Hormone replacement therapy and prevention of vertebral fractures: a meta-analysis of randomised trials. BMC Musculoskelet Disord 2001; 2: 7–14

    Article  PubMed  CAS  Google Scholar 

  70. Fleurence R, Torgerson DJ, Reid DM. Cost-effectiveness of hormone replacement therapy for fracture prevention in young postmenopausal women: an economic analysis based on a prospective cohort study. Osteoporos Int 2002; 13: 637–43

    Article  PubMed  CAS  Google Scholar 

  71. Tosteson AN, Rosenthal DI, Melton III LJ, et al. Cost effectiveness of screening perimenopausal white women for osteoporosis: bone densitometry and hormone replacement therapy. Ann Intern Med 1990; 113: 594–603

    PubMed  CAS  Google Scholar 

  72. Rossouw JE, Anderson GL, Prentice RL, et al. Writing Group for the Women’s Health Initiative Investigators: risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002; 288: 321–3

    Article  PubMed  CAS  Google Scholar 

  73. Beral V. Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet 2003; 362(9382): 419–27

    Article  PubMed  CAS  Google Scholar 

  74. Delmas PD, Bjarnason NH, Mitlak BH, et al. Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. N Engl J Med 1997; 337: 1641–7

    Article  PubMed  CAS  Google Scholar 

  75. Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 1999; 282: 637–45

    Article  PubMed  CAS  Google Scholar 

  76. Cummings SR, Eckert S, Krueger KA, et al. The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial: multiple outcomes of raloxifene evaluation. JAMA 1999; 281: 2189–97

    Article  PubMed  CAS  Google Scholar 

  77. Chapuy MC, Pamphile R, Paris E, et al. Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study. Osteoporos Int 2002; 13: 257–64

    Article  PubMed  CAS  Google Scholar 

  78. Dawson-Hughes B, Harris SS, Krall EA, et al. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997; 337: 670–6

    Article  PubMed  CAS  Google Scholar 

  79. Chapuy MC, Arlot ME, Delmas PD, et al. Effect of calcium and cholecalciferol treatment for three years on hip fractures in elderly women. BMJ 1994; 308: 1081–2

    Article  PubMed  CAS  Google Scholar 

  80. Greenspan SL, Schneider DL, McClung MR, et al. Alendronate improves bone mineral density in elderly women with osteoporosis residing in long-term care facilities: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 2002; 136: 742–6

    PubMed  CAS  Google Scholar 

  81. Downs Jr RW, Bell NH, Ettinger MP, et al. Comparison of alendronate and intranasal calcitonin for treatment of osteoporosis in postmenopausal women. J Clin Endocrinol Metab 2000; 85: 1783–8

    Article  PubMed  CAS  Google Scholar 

  82. Adami S, Passed M, Ortolani S, et al. Effects of oral alendronate and intranasal salmon calcitonin on bone mass and biochemical markers of bone turnover in postmenopausal women with osteoporosis. Bone 1995; 17: 383–90

    Article  PubMed  CAS  Google Scholar 

  83. Hosking D, Adami S, Felsenberg D, et al. Once weekly alendronate produces a greater decrease in bone resorption than does daily risedronate. J Bone Miner Res 2002, 17 Suppl 1; SU345

    Google Scholar 

  84. Gurlek A, Bayraktar M, Gedik O. Comparison of calcitriol treatment with etidronate-calcitriol and calcitonin-calcitriol combinations in Turkish women with postmenopausal osteoporosis: a prospective study. Calcif Tissue Int 1997; 61: 39–43

    Article  PubMed  CAS  Google Scholar 

  85. Sambrook P, Geusens P, Keraudren V, et al. Efficacy of fosamax vs evista comparison trial (effect-international): results at 6 months [abstract]. Bone 2003; 32 Suppl. 1: P536

    Google Scholar 

  86. Thomson AB, Marshall JK, Hunt RH, et al. Risedronate Endoscopy Study Group. 14 day endoscopy study comparing risedronate and alendronate in postmenopausal women stratified by Helicobacter pylori status. J Rheumatol 2002; 29: 1965–74

    PubMed  CAS  Google Scholar 

  87. Lanza F, Schwartz H, Sahba B, et al. An endoscopic comparison of the effects of alendronate and risedronate on upper gastrointestinal mucosae. Am J Gastroenterol 2000; 95: 3112–7

    Article  PubMed  CAS  Google Scholar 

  88. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001; 344(19): 1434–41

    Article  PubMed  CAS  Google Scholar 

  89. Delmas PD, Eastell R, Garnero P, et al. Committee of Scientific Advisors of the International Osteoporosis Foundation. The use of biochemical markers of bone turnover in osteoporosis. Committee of Scientific Advisors of the International Osteoporosis Foundation. Osteoporos Int 2000; 11 Suppl. 6: S2–17

    Article  PubMed  Google Scholar 

  90. Bjarnason NH, Sarkar S, Duong T, et al. Six and twelve month changes in bone turnover are related to reduction in vertebral fracture risk during 3 years of raloxifene treatment in postmenopausal osteoporosis. Osteoporos Int 2001; 12: 922–30

    Article  PubMed  CAS  Google Scholar 

  91. Riggs BL. Are biochemical markers for bone turnover clinically useful for monitoring therapy in individual osteoporotic patients? Bone 2000; 26: 551–2

    Article  PubMed  CAS  Google Scholar 

  92. Ravn P, Christensen JO, Baumann M, et al. Changes in biochemical markers and bone mass after withdrawal of ibandronate treatment: prediction of bone mass changes during treatment. Bone 1998; 22: 559–64

    Article  PubMed  CAS  Google Scholar 

  93. Chapurlat RD, Cummings SR. Does follow-up of osteoporotic women treated with antiresorptive therapies improve effectiveness? Osteoporos Int 2002; 13: 738–44

    Article  PubMed  Google Scholar 

  94. Delmas PD, Vrijens B, Roux C, et al. A reinforcement message based on bone turnover marker response influences long-term persistence with risedronate in osteoporosis: The IMPACT Study [abstract]. J Bone Miner Res 2003; 18 Suppl. 2: M330

    Article  Google Scholar 

  95. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996; 312(7041): 1254–9

    Article  PubMed  CAS  Google Scholar 

  96. Kanis JA, Johnell O, Oden A, et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 2000; 11: 669–74

    Article  PubMed  CAS  Google Scholar 

  97. Kanis JA, Oden A, Johnell O, et al. The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 2001; 12: 417–27

    Article  PubMed  CAS  Google Scholar 

  98. Kanis JA, Johnell O, Oden A, et al. Intervention thresholds for osteoporosis. Bone 2002; 31: 26–31

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

There were no sources of external funding used to assist in preparation of this manuscript. The author has no conflicts of interest related to this manuscript. The author is happy to recognize that over the past 10 years he has lectured for and received grant funding from Boehringher Ingelheim, Lilly, MSD, Novartis, Proctor & Gamble, Roche, and Sanofi.

Author information

Authors and Affiliations

  1. Department of Clinical Biochemistry, Royal Liverpool University Hospital, Prescot Street, Liverpool, L69 3GA, UK

    William D. Fraser (Director of the Supraregional)

Authors
  1. William D. Fraser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William D. Fraser.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fraser, W.D. The Burden of Osteoporosis and the Case for Disease Management. Dis-Manage-Health-Outcomes 12, 409–418 (2004). https://doi.org/10.2165/00115677-200412060-00008

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-200412060-00008

Keywords

Search

Navigation